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Cheung STY, Tsang HHL, Cheung PWH, Cheung JPY. Male spondyloarthritis patients and those with longer disease duration have less severe disc degeneration: propensity score-matched comparison. Rheumatol Adv Pract 2024; 8:rkae015. [PMID: 38405075 PMCID: PMC10884529 DOI: 10.1093/rap/rkae015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/14/2024] [Indexed: 02/27/2024] Open
Abstract
Objective Using whole spine sagittal T2 MRI, we aimed to compare the severity and prevalence of disc degeneration (DD) in axial SpA patients vs the general population and to determine any association between spinal inflammation, structural changes, mobility and DD among SpA patients. Methods Two prospectively collected cohorts of SpA patients (n = 411) and the general population (n = 2007) were recruited. Eventually, 967 participants from the populational cohort and 304 participants from the SpA cohort were analysed. Two hundred and nineteen matched pairs were generated by propensity score matching. Imaging parameters, including Pfirrmann grading, disc herniation, high-intensity zone, Schmorl's node, Modic change and anterior marrow change were studied and compared from C2/3 to L5/S1. DD was defined as Pfirrmann grade 4 or 5. Demographic factors, including age, sex and BMI, were collected. Multivariable linear regression was used to determine the association between spinal inflammation [Spondyloarthritis Research Consortium of Canada (SPARCC) spine MRI index], structural changes [modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS)] and mobility (BASMI) with lumbar Pfirrmann score. Results SpA patients had lower prevalence of DD (P < 0.001). The disease stage-stratified regression model showed that SPARCC spinal MRI index was associated with higher lumbar Pfirrmann scores in early disease (β = 0.196, P = 0.044), whereas mSASSS was associated with lower lumbar Pfirrmann scores in later disease (β = -0.138, P = 0.038). Males had higher mSASSS (P < 0.001) and lower odds of whole spine DD (odds ratio = 0.622, P = 0.028). Conclusion SpA patients had lower DD severity than the general population. Males had higher mSASSSs, and increased mSASSS at later disease was associated with less severe DD.
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Affiliation(s)
- Samuel Tin Yan Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
| | - Helen Hoi Lun Tsang
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
| | | | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
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2
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Peng Y, Wu Y, Chen S, Liu Y, Qian H, He Y, Huang H, Cai M, Liu W, Shi G. Circulating cell-free DNA correlate to disease activity and treatment response of patients with radiographic axial spondyloarthritis. Sci Rep 2024; 14:178. [PMID: 38168507 PMCID: PMC10762258 DOI: 10.1038/s41598-023-50543-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 12/21/2023] [Indexed: 01/05/2024] Open
Abstract
Microdamage and its related inflammation contribute to the development of radiographic axial spondyloarthritis (r-axSpA). Inflammation and cell death in damaged tissues are associated with cell-free DNA (cfDNA) release. Here we investigated whether circulating cfDNA could be a potential biomarker for evaluating disease activity and treatment response in r-axSpA. Circulating cfDNA was detected in the discovery and validation cohort with 79 and 60 newly diagnosed r-axSpA patients respectively and 42 healthy controls using the Quant-iT PicoGreen dsDNA reagent and kit. As a result, cfDNA levels were significantly higher in r-axSpA patients compared with healthy controls in the discovery and validation cohort. Moreover, cfDNA levels were positively correlated with CRP, ASDAS-CRP and neutrophil counts. Additionally, non-steroid anti-inflammatory drugs (NSAIDs) combined with disease-modifying anti-rheumatic drugs or tumor necrosis factor inhibitors but not NSAIDs alone could reduce cfDNA levels. Moreover, a decrease of cfDNA levels after treatment was associated with an effective therapeutic response. Intriguingly, patients with higher levels of cfDNA at diagnosis responded better to combination therapy rather than NSAIDs. However, patients with lower levels of cfDNA displayed similar responses to combination or mono-NSAID treatment. In conclusion, circulating cfDNA levels showed a significant correlation with disease activity as well as treatment efficacy in patients with r-axSpA. Moreover, cfDNA at diagnosis might predict the response to different therapy. Consequently, cfDNA may serve as a useful biomarker of inflammation in r-axSpA.
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Affiliation(s)
- Yun Peng
- Department of Rheumatology and Clinical Immunology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
- Xiamen Municipal Clinical Research Center for Immune Diseases, Xiamen, Fujian, China
- Xiamen Key Laboratory of Rheumatology and Clinical Immunology, Xiamen, Fujian, China
| | - Yuanhui Wu
- Department of Rheumatology and Clinical Immunology, Jiangxi Provincial People's Hospital Affiliated of Nanchang University, Nanchang, Jiangxi, China
| | - Shiju Chen
- Department of Rheumatology and Clinical Immunology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
- Xiamen Municipal Clinical Research Center for Immune Diseases, Xiamen, Fujian, China
- Xiamen Key Laboratory of Rheumatology and Clinical Immunology, Xiamen, Fujian, China
| | - Yuan Liu
- Department of Rheumatology and Clinical Immunology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
- Xiamen Municipal Clinical Research Center for Immune Diseases, Xiamen, Fujian, China
- Xiamen Key Laboratory of Rheumatology and Clinical Immunology, Xiamen, Fujian, China
| | - Hongyan Qian
- Department of Rheumatology and Clinical Immunology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
- Xiamen Municipal Clinical Research Center for Immune Diseases, Xiamen, Fujian, China
- Xiamen Key Laboratory of Rheumatology and Clinical Immunology, Xiamen, Fujian, China
| | - Yan He
- Department of Rheumatology and Clinical Immunology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
- Xiamen Municipal Clinical Research Center for Immune Diseases, Xiamen, Fujian, China
- Xiamen Key Laboratory of Rheumatology and Clinical Immunology, Xiamen, Fujian, China
| | - Heqing Huang
- Department of Rheumatology and Clinical Immunology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
- Xiamen Municipal Clinical Research Center for Immune Diseases, Xiamen, Fujian, China
- Xiamen Key Laboratory of Rheumatology and Clinical Immunology, Xiamen, Fujian, China
| | - Meimei Cai
- Department of Rheumatology and Clinical Immunology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
- Xiamen Municipal Clinical Research Center for Immune Diseases, Xiamen, Fujian, China
- Xiamen Key Laboratory of Rheumatology and Clinical Immunology, Xiamen, Fujian, China
| | - Wen Liu
- Department of Rheumatology and Clinical Immunology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China.
- Xiamen Municipal Clinical Research Center for Immune Diseases, Xiamen, Fujian, China.
- Xiamen Key Laboratory of Rheumatology and Clinical Immunology, Xiamen, Fujian, China.
| | - Guixiu Shi
- Department of Rheumatology and Clinical Immunology, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China.
- Xiamen Municipal Clinical Research Center for Immune Diseases, Xiamen, Fujian, China.
- Xiamen Key Laboratory of Rheumatology and Clinical Immunology, Xiamen, Fujian, China.
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Zhang J, Shi X, Wang J, Qi J, Li Y, Jiang H, Sun Q, Gu Q, Li C, Ying Z. Adefovir-induced hypophosphatemic osteochondrosis mimicks ankylosing spondylitis. Int J Rheum Dis 2024; 27:e15040. [PMID: 38287538 DOI: 10.1111/1756-185x.15040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 11/23/2023] [Accepted: 01/03/2024] [Indexed: 01/31/2024]
Affiliation(s)
- Ju Zhang
- Department of Rheumatology and Immunology, Jinzhou Medical University Graduate Training Base Zhejiang Provincial People's Hospital, Center for General Practice Medicine, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China
- Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Institute of Rheumatology and Immunology, Hangzhou Medical College, Zhejiang Key Laboratory of Traditional Chinese Medicine for Arthritis Diagnosis and Treatment, Hangzhou, Zhejiang, China
| | - Xiaojun Shi
- Department of Rheumatology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Jing Wang
- Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Institute of Rheumatology and Immunology, Hangzhou Medical College, Zhejiang Key Laboratory of Traditional Chinese Medicine for Arthritis Diagnosis and Treatment, Hangzhou, Zhejiang, China
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Jiaping Qi
- Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Institute of Rheumatology and Immunology, Hangzhou Medical College, Zhejiang Key Laboratory of Traditional Chinese Medicine for Arthritis Diagnosis and Treatment, Hangzhou, Zhejiang, China
- Bengbu Medical College, Bengbu, Anhui, China
| | - Yixuan Li
- Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Institute of Rheumatology and Immunology, Hangzhou Medical College, Zhejiang Key Laboratory of Traditional Chinese Medicine for Arthritis Diagnosis and Treatment, Hangzhou, Zhejiang, China
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Huan Jiang
- Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Institute of Rheumatology and Immunology, Hangzhou Medical College, Zhejiang Key Laboratory of Traditional Chinese Medicine for Arthritis Diagnosis and Treatment, Hangzhou, Zhejiang, China
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Qiong Sun
- Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Institute of Rheumatology and Immunology, Hangzhou Medical College, Zhejiang Key Laboratory of Traditional Chinese Medicine for Arthritis Diagnosis and Treatment, Hangzhou, Zhejiang, China
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Qinchen Gu
- Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Institute of Rheumatology and Immunology, Hangzhou Medical College, Zhejiang Key Laboratory of Traditional Chinese Medicine for Arthritis Diagnosis and Treatment, Hangzhou, Zhejiang, China
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Chen Li
- Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Institute of Rheumatology and Immunology, Hangzhou Medical College, Zhejiang Key Laboratory of Traditional Chinese Medicine for Arthritis Diagnosis and Treatment, Hangzhou, Zhejiang, China
- Department of Rheumatology, Fangshan Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Zhenhua Ying
- Department of Rheumatology and Immunology, Jinzhou Medical University Graduate Training Base Zhejiang Provincial People's Hospital, Center for General Practice Medicine, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China
- Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Institute of Rheumatology and Immunology, Hangzhou Medical College, Zhejiang Key Laboratory of Traditional Chinese Medicine for Arthritis Diagnosis and Treatment, Hangzhou, Zhejiang, China
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- Bengbu Medical College, Bengbu, Anhui, China
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Chan SCW, Chung HY. MRI for axial SpA: Diagnosis, disease activity assessment, and recent advances. Int J Rheum Dis 2024; 27:e15014. [PMID: 38287559 DOI: 10.1111/1756-185x.15014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 11/12/2023] [Accepted: 12/12/2023] [Indexed: 01/31/2024]
Abstract
Magnetic resonance imaging (MRI) is a sensitive imaging modality to detect early inflammatory changes in axial spondyloarthritis (SpA). Over a decade has passed since the inclusion of MRI assessment in the 2009 Assessment of SpondyloArthritis International Society (ASAS) classification criteria for axial SpA. Evidence and clinical experience of MRI in axial SpA have accumulated rapidly since. This has led to a better understanding of the clinical utility of MRI in early diagnosis, disease activity assessment, and monitoring of treatment response in axial SpA. Furthermore, technological advancements have paved the way for the development of novel MRI sequences for the quantification of inflammation and image optimization. The field of artificial intelligence has also been explored to aid medical imaging interpretation, including MRI in axial SpA. This review serves to provide an update on the latest understanding of the evolving roles of MRI in axial SpA.
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Affiliation(s)
- Shirley Chiu Wai Chan
- Division of Rheumatology and Clinical Immunology, Department of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Ho Yin Chung
- Division of Rheumatology and Clinical Immunology, Department of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
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Pei J, Zheng Y, Zhang K, Jia J, Ding J, Zheng Z, Shang L, Zhu P. Exploring physical function and physical activity in axial spondyloarthritis: Beyond clinical remission or low disease activity. Int J Rheum Dis 2024; 27:e14985. [PMID: 38037272 DOI: 10.1111/1756-185x.14985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 09/26/2023] [Accepted: 11/12/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVES To investigate the crucial roles of physical function (PF) and physical activity (PA) in axial spondyloarthritis (axSpA) patients, as well as their correlation with disease activity (DA), and to explore the influence of general characteristics among them. METHODS We enrolled axSpA patients from Xijing Hospital, spanning March 2022 to August 2022. Spearman rank correlation coefficients were used to assess correlations between PA (measured by the Global Physical Activity Questionnaire [GPAQ]), PF (measured by the Assessment of Spondyloarthritis international Society Health Index [ASAS-HI], the Short Form 36-Item Health Survey [SF-36], and the Bath Ankylosing Spondylitis Functional Index [BASFI]), DA, and their influencing factors. A Mann-Whitney U-test and Kruskal-Wallis H-test were used to compare variables between different patients grouped by sex, human leukocyte antigen B27 (HLA-B27), hip involvement, and intensity of PA and DA. RESULTS Three hundred fifty-five axSpA patients were included. We observed a moderate to strong correlation between DA and PF in axSpA patients. PA was weakly correlated with DA or PF. DA varied significantly at different PA levels, and patients with low PA levels had poorer PF. Active patients had worse PF, less transport-related PA, and a higher rate of hip involvement with a worse Harris Hip Score (HHS). CONCLUSIONS We identified a close relationship between DA, PF, and PA in axSpA patients. Further, gender, HLA-B27, and hip involvement affected the clinical manifestation of axSpA patients. These findings demonstrate that clinical remission of axSpA patients requires a comprehensive assessment rather than a single remission of DA.
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Affiliation(s)
- Jin Pei
- Department of Clinical Immunology, Xijing Hospital, Fourth Military Medical University, Xian, China
| | - Yan Zheng
- Department of Clinical Immunology, Xijing Hospital, Fourth Military Medical University, Xian, China
- National Translational Science Center for Molecular Medicine, Xi'an, China
| | - Kui Zhang
- Department of Clinical Immunology, Xijing Hospital, Fourth Military Medical University, Xian, China
- National Translational Science Center for Molecular Medicine, Xi'an, China
| | - Junfeng Jia
- Department of Clinical Immunology, Xijing Hospital, Fourth Military Medical University, Xian, China
- National Translational Science Center for Molecular Medicine, Xi'an, China
| | - Jin Ding
- Department of Clinical Immunology, Xijing Hospital, Fourth Military Medical University, Xian, China
- National Translational Science Center for Molecular Medicine, Xi'an, China
| | - Zhaohui Zheng
- Department of Clinical Immunology, Xijing Hospital, Fourth Military Medical University, Xian, China
- National Translational Science Center for Molecular Medicine, Xi'an, China
| | - Lei Shang
- Department of Health Statistics, Fourth Military Medical University, Xian, China
| | - Ping Zhu
- Department of Clinical Immunology, Xijing Hospital, Fourth Military Medical University, Xian, China
- National Translational Science Center for Molecular Medicine, Xi'an, China
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Kim Y, Lee SK, Kim JY, Kim JH. Pitfalls of Diffusion-Weighted Imaging: Clinical Utility of T2 Shine-through and T2 Black-out for Musculoskeletal Diseases. Diagnostics (Basel) 2023; 13:diagnostics13091647. [PMID: 37175036 PMCID: PMC10177815 DOI: 10.3390/diagnostics13091647] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/30/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023] Open
Abstract
Diffusion-weighted imaging (DWI) with an apparent diffusion coefficient (ADC) value is a relatively new magnetic resonance imaging (MRI) sequence that provides functional information on the lesion by measuring the microscopic movement of water molecules. While numerous studies have evaluated the promising role of DWI in musculoskeletal radiology, most have focused on tumorous diseases related to cellularity. This review article aims to summarize DWI-acquisition techniques, considering pitfalls such as T2 shine-through and T2 black-out, and their usefulness in interpreting musculoskeletal diseases with imaging. DWI is based on the Brownian motion of water molecules within the tissue, achieved by applying diffusion-sensitizing gradients. Regardless of the cellularity of the lesion, several pitfalls must be considered when interpreting DWI with ADC values in musculoskeletal radiology. This review discusses the application of DWI in musculoskeletal diseases, including tumor and tumor mimickers, as well as non-tumorous diseases, with a focus on lesions demonstrating T2 shine-through and T2 black-out effects. Understanding these pitfalls of DWI can provide clinically useful information, increase diagnostic accuracy, and improve patient management when added to conventional MRI in musculoskeletal diseases.
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Affiliation(s)
- Yuri Kim
- Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Seul Ki Lee
- Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Jee-Young Kim
- Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Jun-Ho Kim
- Department of Orthopaedic Surgery, Center for Joint Diseases, Kyung Hee University Hospital at Gangdong, Seoul 05278, Republic of Korea
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Hu S, Xing H, Wang X, Zhang N, Xu Q. Causal Relationships Between Total Physical Activity and Ankylosing Spondylitis: A Mendelian Randomization Study. Front Immunol 2022; 13:887326. [PMID: 35865535 PMCID: PMC9294357 DOI: 10.3389/fimmu.2022.887326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background Currently, there is little literature about the association between physical activity (PA) and the risk of ankylosing spondylitis (AS). The present study aimed to understand the causal relationships between PA and AS. Methods We performed two-sample Mendelian randomization (MR) using publicly released genome-wide association studies summary statistics to estimate the causal associations of PA with AS risk. The inverse variance weighted (IVW) method was utilized as primary MR analysis. Furthermore, sensitivity, pleiotropy, and heterogeneity analyses were then conducted to assess the robustness of the findings of the present study. Results Results of the IVW analysis suggested a protective relationship between accelerometer-based PA and AS (average acceleration, odds ratio [OR] = 0.9995, 95% CI, 0.9988–0.9999, P = 0.014). On the contrary, there was no causal relationship between accelerometer-based PA (acceleration fraction >425 mg; OR = 0.9981, 95% CI = 0.9936–1.0026, P = 0.402) and AS. Furthermore, there was no significant relationship between self-reported vigorous PA and AS (OR = 1.0005, 95% CI = 0.9875–1.0136, P = 0.943), or even between self-reported moderate-to-vigorous PA and AS (OR = 1.0000, 95% CI, 0.9947–1.0052; P = 0.990). Conclusions The use of genetic approach in the present study revealed that total physical activity (TPA) has a protective relationship with AS risk. Furthermore, it was evident that vigorous PA or moderate-to-vigorous physical levels are not causally associated with AS. Therefore, the present study evidently supports the hypothesis that enhancing TPA rather than PA intensity is an effective prevention strategy for AS.
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Affiliation(s)
- Shaojun Hu
- Department of Orthopaedics, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Hongyuan Xing
- Department of Orthopaedics, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xingchen Wang
- Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Department of Cardiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ning Zhang
- Department of Orthopaedics, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- *Correspondence: Ning Zhang, ; Qiang Xu,
| | - Qiang Xu
- Department of Orthopaedics, Xuzhou Central Hospital, Xuzhou, China
- *Correspondence: Ning Zhang, ; Qiang Xu,
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